Public Opting

A friend received her emergency room bill in this week’s mail. She opened it with trepidation, scanning down the complicated billing data to the bottom line. It came to $1.90.

Welcome to the Public Option.

Kathleen is entitled to VA health care. Alongside Medicare and Medicaid, the VA has long operated a multi-generational beta test for single-payer health care. Kathleen receives physical therapy for her back, birth control, an annual complete physical and “out-of-network” (i.e. non-VA) coverage for emergency care. Prescriptions refilled over the web show up regularly in Kathleen’s mailbox. The VA grinds her a new pair of glasses every couple of years; more often if her prescription changes or she loses her specs. She is entitled to unlimited mental health coverage.

Sounds pretty good to me. But while socialized medicine may suffice for our vets and geezers, I’m told productive citizens should fear it.

A typical objection is that our Gub’mint couldn’t pour piss out of a boot if you printed the instructions on the sole. That would be the same government that commissioned our interstate highway system, devised nuclear propulsion systems, broke the sound barrier, prototyped the internet and won the Cold War.

Okay, sure, but what can sinecured federal drones bring to the medical arts? Modern trauma care came straight out of M.A.S.H. tents in Korea and Viet Nam. Brooke Army Medical Center leads the world in treating chemical, electrical and thermal burns. Walter Reed Hospital breaks new ground daily in prosthetic development, fitment and adaptation. PTSD understanding was spearheaded by Veterans Administration psychologists. Every doctor in America respects the epidemiological research of the Centers for Disease Control and Prevention, and the President himself receives medical care at Bethesda Naval Hospital.

But is it fair to require misunderstood health group coordinators compete against a taxpayer-funded public health plan?

Federal Express, UPS and DHL have all arisen to compete handily against a Postal Service that will still deliver a letter to Aunt Sarah in St. Petersburg for 44 cents. Private schools from kindergarten to college thrive by offering competitive alternatives to the public school system. Public option health care should leave at least a little wiggle room in the medical marketplace for cosmetic dentists, LASIK outlet stores and talented breastmongers servicing the misunderstood fangirls of Nip/Tuck.

What about rationing? In the worker’s paradise formerly known as the United Soviet Socialist Republics, dachas were distributed in the feudal tradition. The climb from drafty shack to a Black Sea chalet with capitalist toilet paper required stout political pull. How fairly will care be doled out under Obamunism?

First, let’s look at how private rationing works.

Women are regularly divested of health care coverage because of the “pre-existing” condition of having suffered domestic violence. Women — and, to a lesser degree, men — who accept AIDS medication following a rape are routinely blacklisted from medical coverage for six months to a year or more.

It’s tough luck for the assaulted, but at least they’re not alone. A diagnosis of cancer sends case managers scrambling to “justify” denying care. Spouses lose their coverage when they are on a plan through their partner’s employer and the partner dies, loses his or her job — or is kicked off the plan because he or she actually got sick.

What happens to their children?

Those underinsured slobs should have avoided having kids in the first place. Maternity coverage is excluded from millions of policies – inconveniently, the same policies that exclude coverage for birth control or abortion. Many policies that do cover birth specifically exclude such birthday surprises as Downs Syndrome, cleft palate and cerebral palsy.

HMOs also work both ends toward the middle. While patients are systematically pushed off their plans before major medical costs arise, up-front preventive care costs for tests and annual visits are intentionally minimized or transferred to the patient. That impeaches your prospects for long-term health.

Furthermore, many of what you and I may consider routine requirements are often classified as out-of-plan luxuries by insurers. Those would include glasses, birth control and orthodontia.

That’s how rationing works for us right now, Gentle Citizen. And it saves taxpayers or policyholders not one nickel when another unfortunate is thrown onto the mercies of emergency care. It only saves the relieved corporation. Where do you think those costs get spread, once they’re disowned by insurers?

This is all perfectly legal in a country where the right to life, liberty and the pursuit of happiness includes no entitlement to health care.

Happily, it doesn’t work that way for every American. Veterans are covered by a system of VA hospitals and clinics that, while imperfect, never turns away a sailor because she was raped, or denies coverage to an old sergeant because he smokes. Constrained by austere government rationing, my dinged-up army buddy Kathleen has probably received more government health care this year than the entire Obama family, at a comparable level of quality.

Some children qualify for SCHIP since we got sick of kicking away Tiny Tim’s crutch. Medicare exists because seniors got rationed right out of the private market, and the spectacle of watching Grandma get her plug pulled by profit-motivated corporations finally got too disgusting even for Congress. All these programs qualify as effective test versions of single-payer health care, and each of them arguably functions better than private sector health care in our country.

That is, if “functioning” is rated by our survival rate, rather than the bottom line. Remember that “death panels” weren’t invented by government bean counters, or even by talk radio corporate shills. They were conceived by private actuaries.

Despite spending more — both per capita and in gross dollars — on health care than any other nation on Earth, the United States of America ranked 37th in the world for life expectancy, based on the 2008 estimates of our own Central Intelligence Agency.

This year, our position dropped to 50th.

Time to be angry yet? Countries offering universal social insurance — places like Japan, Great Britain, Iceland, Sweden, Canada and those cheese-eating surrender monkeys in France — dominate the top 20, while we languish in the company of Albania, Costa Rica and Libya.

Some citizens are already angry. On October 20th, Pres. Obama’s “Organizing for America” group, a kind of national-level community organizing arm, asked citizens to make 100,000 telephone calls to their senators and representatives in support of the President’s health care proposal. By that afternoon, Congress had fielded over 300,000 calls, each demanding a robust public option and health insurance for every American. It’s probably some kind of record in U.S. politics, but that may not matter.

Congressional members, playing political football with their helmets off, now lean toward scrapping the public option — yet retaining a requirement for every citizen to carry health insurance. That’s good news for anyone heavily invested into insurance stocks, but the worst of both worlds for taxpayers.

Why would Congress even consider that? Because private insurance is protected by the best laws money can buy. Loyal Taxpayer, you may pay Congress’s actual salaries, but they aren’t bought so cheaply as that.

The scandal of Congress voting itself lifetime health care benefits at taxpayer expense and authorizing Special Forces MEDCAP missions to Botswana villages — while denying well child visits to American schoolchildren — is explainable only one way: envelopes of insurance lobby dollars slipped into their pockets. That “robust private option” got skimmed off the premiums you paid to insurance companies, which certainly guaranteed that it wouldn’t go to support your health.

In fact, that cash was specifically spent to minimize your coverage. America’s Health Insurance Plans (AHIP), the velvet-gloved lobbying fist of health insurers, recently inoculated the hallowed halls of Congress with a few more of its millions to reduce the minimum insurer obligation for covered conditions from 76 percent to 65 percent.

AHIP is further negotiating to limit availability of any public option for health care to those who are currently completely uninsured, and to tie premiums for single-payer care to rates already charged in the private marketplace. They’re essentially buying a Congressional non-compete clause, and it will cost you more than it costs AHIP.

According to the Congressional Budget Office, kneecapping a robust public option that will force insurers to compete effectively won’t save taxpayers anything. Moreover, it will cost we the poorly insured people an extra $110 billion in the long run. That’s a direct giveaway of tax money to reduce the health of the commonwealth.

So tell me, would you rather continue to pay insurance companies to lobby against you, or pay taxes to ensure that you’ll always receive at least baseline health care?

Perhaps it makes no difference what you think, or what I think, or even what all of us articulate in one strong, united voice. Our legislators could be so confident of their incumbencies that they’ll press the keys to the candy store back into insurers’ sticky fingers.

What will you do then?

Remember when 93 percent rejected bailing out the very Wall Street plutocrats who crashed the whole world’s economy? Republicans and Democrats and Independents and Libertarians and Communists, cats and dogs and fish… everyone and their cousin opposed that brobdingnagian debacle.

They took our money anyway.

Official unemployment figures still hover around 10 percent — the highest in my lifetime — but you’ll be happy to note that “The Economy” recovered sufficiently that head-of-the-line bailout stars Goldman Sachs and AIG each paid record employee bonuses this year. In a market economy, that means just one thing: insurance lobbyists are grievously underpaid!

Perhaps we should wait to see if our tax-funded largesse to brokers will give us all a warm feeling this year as we turn down our wintertime heat, hoping we can still afford to insure the kids on the scrapings of our unemployment benefits… and maybe even buy them a handful of Chinese melamine candies for Christmas.

Or maybe we should remind our Congressional employees that they’re not running for corporate board seats where it’s one vote per share and the biggest wallet wins, but for a national leadership trust where it’s one vote per citizen and they represent all of us for better, for worse; for richer, for poorer; in sickness and in health.

Of life, liberty and the pursuit of happiness, the first among these is life.